Guided life-review helps moderate depression

NEW YORK (Reuters Health) - A self-help process aimed at
better understanding and accepting life events benefited
depressed middle aged and older adults in a small Dutch trial.

Participants rated the 10-week "life-review" program highly
and showed reduced depression and anxiety for up to a year
afterwards, researchers say.

"Life-review is taking perspective," Ernst Bohlmiejer, a
co-author of the study, told Reuters Health. "At a certain
moment one realizes that life is short and has an ending.
Life-review makes you slow down and ask yourself some important
questions."

Life-review, described as a structured evaluation of one's
past, has been found effective against depression among older
people, the authors write in The Journals of Gerontology: Series
B.

But it was unclear if the approach would help people as
young as 40 and if it could work as a guided self-help program
rather than a face to face therapy.

The research group, from the University of Twente in
Enschede, the Netherlands, recruited applicants age 40 and older
with mild to moderate depression symptoms and excluded those
currently or previously receiving psychological treatment or
medication.

The 174 participants, whose median age was about 57, were
then divided into three groups with 58 people in each. One group
did the life-review program, another was put on a waiting list
for the program to act as a comparison, and a third group was
assigned to an expressive writing program as a more active
comparison.

The life-review group received the book The Stories We Live
By, written by Bohlmiejer, and completed a series of seven
modules over the course of ten weeks. The first four modules
prompted participants to associate both a positive and a
difficult memory with themes such as childhood, family, and
friendship, while the last three modules asked them to sum up
the experience and focus on the future.

The expressive writing intervention consisted of daily
writing about emotional experiences for 15 to 30 minutes on
three to four consecutive days. It had seven modules that moved
from a focus on negative experiences to a focus on positive
ones, and ended with participants writing a letter to a friend.

Both groups also received email guidance from counselors,
but to varying degrees. The life-review group received narrative
counseling that included specific questions encouraging
participants to reframe their negative memories.

The expressive writing group only received positive feedback
on the process, keeping the writing exercises open and
unstructured.

The researchers, led by Sanne Lamers, measured depression
and anxiety symptoms before the interventions and three months
later. Both intervention groups showed marked reductions in
depression symptoms, although there was little difference
between the two.

On a scale of 0 to 60, with a higher score representing
worse depression, the life-review participants started with an
average score of 24.31, which fell to 15.88 after three months.
The writing group started with an average score of 23.91, which
fell to 14.55.

Even the waiting list group showed a small decrease in
depression symptoms, from an average score of 22.9 to 18.75.

The results were less dramatic for anxiety symptoms,
measured on a scale of 0 to 21. Scores for both the life-review
and expressive writing participants fell by more than 2 points,
while the waiting list group's score fell by 1.53.

For the life-review and expressive writing groups, the
researchers measured symptoms again at six months and 12 months.
The results seemed to waver but remained lower than where the
participants began.

The life-review group's depression symptoms jumped to 17.59
at six months but fell to 15.83 at 12 months, while the
expressive writing group score steadily rose to 15.62 after six
months and 17.37 at 12 months.

The longer-term measurements fill an important gap in
understanding the effects of life-review, Lamers and her
colleagues point out in their report.

"Life-review can help depressed people to feel better when
they follow a course at home with a self-help book and
counseling by e-mail. This is a new insight, because to date
life-review was only studied as a face-to-face therapy, either
individual or in a group," Lamers told Reuters Health.

"Life-review not only works for older adults, but also for
middle-aged adults of 40 years and over," she said. "Life-review
is mainly applied in older adults and our results show that it
is relevant for other age groups as well."

Bohlmiejer thinks the results show the effectiveness of
life-review in reflecting and reconsidering life stories. When
you are depressed you can lose sight of the larger picture and
focus too much on the negative details, he said. "There are
always positive exceptions and memories about positive events.
These are starting points for other stories."

The World Health Organization says that worldwide more than
350 million people of all ages suffer from depression and that
fewer than half of them receive effective treatment. Lamers said
life-review is a process that many can easily adopt.

"Recollecting memories is something we all do in our
everyday lives. This makes life-review such a great therapy
because we can use a relatively easy activity we are all
familiar with to make people feel better," she said.

SOURCE: http://bit.ly/1je2FR1 The Journals of Gerontology:
Series B, online April 1, 2014.